How much scope is there for poor judgement or mood fluctuation before it’s deemed psychopathology?
This timeless and universal debate has reignited over the past few months after the May 2013 publication of the DSM-5. This new version of the “psychiatrist’s bible” was 14 years in the writing.
The Diagnostic and Statistical Manual of Mental Disorders is an attempt to provide doctors with a definitive list of all recognised mental health conditions, including their symptoms. But attempting to categorise mental illnesses in black and white terms is fraught with danger.
The two main criticisms of the DSM-5 are that the revisions showcase:
- an unhealthy influence of the pharmaceutical industry
- an increasing tendency to ‘medicalise’ patterns of behaviour and mood that are not pathological
The first version of the DSM was published in 1952. Since then, the manual has been periodically updated to keep up with society’s evolving understanding of mental health.
The most scathing criticism of the DSM-5 relates to what constitutes major depressive disorder. Previous definitions described MDD as a persistent low mood, loss of enjoyment, and disruption to everyday activity.
These definitions specifically excluded a diagnosis of MDD if the person was recently bereaved – an exception that has now been removed.
A range of individuals and organisations have argued that the DSM-5 is “medicalising grief”. The argument is that grief is a normal (though unpleasant) human process that should not require treatment with antidepressants.
In defence of the DSM updates, a standardised diagnostic guide is invaluable to doctors. While the DSM may be a flawed classification system it’s probably better than anything else currently available.
You can find out all about the DSM-5 here.
What are your thoughts on ‘classifying’ mental illness? Is it useful or futile?